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Efective Implementation of a Structured Psychoeducation Programme among Caregivers of Schizophrenia Patients in the Community
4.6 Feasibility of the psychoeducation programme 4.6.1
Duration in service of staff
There were a total of 10 staffs involved in the teaching of the psychoeducation module to caregivers. They consisted of medical assistants and staff nurses
working in the respective health clinics. 8 80 of them had been working for more than 10 years and the remaining worked for 6-10 years.
4.6.2 Opinions of staff regarding the psychoeducation programme
Staffs involved in the teaching of the psychoeducation module were asked regarding the feasibility of the programme Table 7. All 10 were satisfied in
giving the psychoeducation programme. All agreed that the programme should be continued and that they would like to be given incentives. Almost
all of them 90 agreed that the psychoeducation programme is beneficial to the patient and they had support from the other staff in implementing
the programme. 80 agreed that the module was easy to implement but admitted that it was too time consuming. However, more than half of them
60 found the program a burden.
5.0 DISCUSSION
5.1 Key findings 5.1.1
Socio-demographics of respondents
In our study, there were more male caregivers in the intervention group as compared to the control group. We postulate that male caregivers were
more likely to be able to come for follow-up. Further analysis needs to be done to find out the reason for this observation. The distribution of Malay,
Chinese, and Indian caregivers were similar in the intervention and control groups. However, there were significantly more caregivers of other ethnicity
in the intervention group. This was perhaps due to the small sample size of other ethnicity.
The duration as a caregiver was significantly shorter in the intervention group as compared to the control group. One possible reason could be
that the caregivers are more receptive to the patients’ illness in the initial period of their illness. More caregivers in the interventional group have a
household income of more than RM 1,500 as compared to the control group. One possible reason for this was a significant number 23.6 of caregivers
in the control group did not divulge their household income.
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Efective Implementation of a Structured Psychoeducation Programme among Caregivers of Schizophrenia Patients in the Community
Schizophrenic patients in the intervention group have a shorter duration of illness. This is reflected in the profile of the caregivers in the intervention
group, who had shorter duration as a caregiver. It is possible that this group of patients and their caregivers are more keen to learn about the disease
in the earlier years.
5.1.2 Knowledge of caregivers on schizophrenia
There was a significant increase in the knowledge of the caregivers in the intervention group after the psychoeducation module was given, and the
knowledge increment was sustained after 3 months. At 6 months there was no further knowledge increment but the score did not drop. This was the
result of the continuous structured psychoeducation given to the caregivers. Furthermore, the staffs gave consistent attention to the caregiver and their
patients and helped contribute to the increase in knowledge. During the study period, any uncertainties and doubts could be clarified as and when
needed.
In the control group, there was modest but insignificant improvement in the knowledge scores of caregivers. The slight initial improvement observed
was probably due to the extra attention given by the staff during the study period. This gave rise to increase in awareness and interest among
caregivers and patients, thus leading to improved scores even though no psychoeducation given. This observation is explained by the Hawthorne
effect.
Among the questions, knowledge on the following questions were poorly answered and understood: definition of symptoms such as hallucinations
and delusions, the belief that medication is only necessary if the patient is not well, early warning signs and symptoms indicating relapse, and the
interference of alcohol and drugs in the illness.
5.2 Comparison with other studies 5.2.1 Readmission rates
Overall, there was no significant difference in the readmission rates between both groups. One possible reason for this is the short study duration of 6
months. A similar study by Chien Wong Chien WT et al., 2007 showed that readmission rates were reduced when patients were followed up over
a period of 12 months. Two recent systematic reviews Pekkala E et al., 2002; Pharoah FM et al., 2003 reported that patients whose families received
psychoeducation had reduced relapse rates of 4-fold after 1 year, and 2-fold the subsequent year. Another study by Aguglia and colleagues Aguglia E
